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I SEWAGE l.�, t e <br /> Distance to Public Sewers �_ Connection necessary: Yes ,D10 ✓ <br /> Does existing septic system comply with Ord . #549 : Yes No_ <br /> Unknown If no, explain: <br /> -{�-�4 -0 -7(-,2 /-s�- <br /> Describe septic installation to be installed11: <br /> (.�c r( `�cs well � a�i l.`�--. ✓�,�2 e_-E- 'moi f I L 2 2 .f��rQ c rd S ,. <br /> 2 . WATER SUPPLY coo- ersys-�.�.� <br /> Is water s plied by private well : Yes '� do Is well proper: <br /> Yes No LL State deficiency : nn --7-- / <br /> K ST, c vYiQ S`{� Gyre t vt9 .Se_o_G cl l "V.l a•.e - o✓e r <br /> v✓l1 r d" c�Q S C rn�lE cl �J¢ cel a <br /> Does existing or rrrpose use make this well pub is water: Yes t✓ <br /> No Sample of we water taken: Yes No Date taken <br /> Results Additional information or comments <br /> S .af(ati) Vjac_rl rzedS 4((2d r . W, f2� Gtlaw <br /> r r ,ti'k�-. C,I Q .DP c ox c k /j�men f Ea c( .4-e c G,,s-f>t-t c��e d , <br /> 3 . GARBAGE & REFUSE <br /> Licensed scavenger pick-up: Yes No Service Area No. <br /> Other proposed disposalmethod: <br /> Potential problem: 0 <br /> 4 . FLY , MOSOUTTO OR YTCTOR PQ'r2iNTIA <br /> State possible vectod3)q potentiztl & necessary control: <br /> 5 . TnILF.T/BATH FAcTT,TTES <br /> No . & location existing: Additional <br /> facilities needed <br /> 6 . pggymns c:PLRATION HISTORY <br /> u A- <br /> 7 . GENERAL SANTTATTON <br /> State any Problem-- ,7't PreviouW17 notal : <br /> D "j 'E� <br /> 3 . PnPCI .ATIf3 E243TTY <br /> Appx . No . People per sq . mi . <br />